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Marginal Placenta Previa Birth

Things had been going well until one morning I went to the bathroom and noticed that the toilet was full of blood. I’d passed a small blood clot at 30 weeks but we had just finished moving and I knew I’d been overexerting myself. It concerned me but I wasn’t going to run off to the hospital just because of a small blood clot so I took a number of days of bed rest and since there wasn’t any more blood I figured that whatever the problem was had resolved itself.

DIAGNOSIS

But, then at 34 weeks, there was a lot of blood. Bright red and painless. I knew what that likely meant but I was really hoping it would be something else, like maybe an irritated cervix from doing too much laundry or something. But no, when I went to the hospital and had an ultrasound the doctor told me exactly what I didn’t want to hear, “It’s very concerning, your placenta is beside your cervix…it’s definitely a previa.” I live on an island and the biggest hospital only has a basic ultrasound machine, so the u/s I had was only able to show the placenta beside my cervix. In order to find out whether it was attached to my cervix or just near to it, and exactly how near, I had to go to a hospital on the mainland and have a transvaginal ultrasound. So yuck, I never do things like that, but I talked with my husband and we agreed that it was necessary information so the appointment was made.

I had about six days in between my previa diagnosis and my next u/s and they were a very long six days. Mostly I cried a lot and didn’t sleep and spent a lot of time trying to imagine myself having a cesarean, which I couldn’t. When I wasn’t torturing myself with visions of nightmare birth scenarios I was researching, gathering information on the different types of previa. It was hard, there aren’t a lot of good ‘placenta previa’ stories out there. It was scary because, well, placenta previa is bad. It’s one of the few birth complications that are actually really a problem. The placenta is supposed to come after the baby, not before. So it was stressful times. If the placenta was attached to my cervix I was screwed, not much chance of a normal birth there, but if it was beside my cervix so that it could open without making my placenta bleed, I had hope.

My appointment was with a maternal-fetal medicine specialist at a large teaching hospital. Total twilight zone for me. My first three births were unassisted so the only other obstetrician I’d met was the one who diagnosed my previa. I had my appointment and they took a number of measurements of my baby, which I didn’t think were necessary except that they’d done it at my previous u/s and had said my baby looked ‘small’ and that my fluid was possibly ‘low’. I thought both suggestions were likely bullshit but I was also a bit concerned because placenta previa can be associated with other placenta abnormalities and birth defects. Thankfully, my baby and placenta were both normal. The placenta itself was posterior, on the left, and 1 cm away from my cervix. He estimated that the distance would increase to 2 cm over the next few weeks and that vaginal birth was possible but that a home birth was out of the question. The hospital also manages the midwives for the province and he said that “none of the midwives here would be willing to attend this at home”. (Well good for them, I had thought.) He seemed to have some kind of highly monitored hospital birth in mind, he mentioned that they’d like to check my progress regularly and monitor me in other ways, which didn’t sit well with me. I was very relieved to know I didn’t need to schedule a c-section, but still the mention of a highly-monitored hospital birth really got my back up. It’s incomprehensible how these medical people assume I’m going to allow a number of strangers to stick their hands up me while I’m in labour. But I digress…

At that point I was planning a low-intervention hospital birth, or at least that was what I was telling myself. I really couldn’t picture myself giving birth in a hospital but at the same time I didn’t feel like I had much choice. I mean, placenta previa is “bad”, that and a cord prolapse are the two things that are really serious life-threatening problems, the kind that you don’t want to deal with at home. I also think I was still a little stunned from finding out about the previa, and knowing that an automatic c/s was off the table made a hospital birth seem almost palatable for a while. And it wasn’t like the fact that it was a marginal previa meant that everything was going to be okay, there are still a number of complications that can arise when the placenta is in the lower half of the uterus and that close to the cervix. One involves bleeding before the baby is born, the other involves bleeding after, and neither is good.

I spent the 35th week of my pregnancy trying to imagine a hospital birth and gathering information from people who knew about hospital birth and about placenta previa. My biggest concern was that my placenta would start bleeding in labour and I’d have to have a c-section anyway. I’m an herbalist and a student of Susun Weed so I called her for advice. She suggested a half-gallon a day of herbal infusions, alternating nettle, comfrey and raspberry leaf. I’d already ordered nettle and raspberry but it hadn’t occurred to me to drink that much, so I had to find local sources where I could buy it by the pound. So that started me on infusions, I drank at least 2 liters a day for the rest of my pregnancy. The other thing Susun recommended was visualization. At least once a day I spent at least five minutes visualizing the bottom edge of my placenta toughening up and adhering strongly to my uterus, and then I’d see it moving, crawling slowly upward toward the top of my fundus. When I’d drink my infusions I’d picture this and I’d remind myself what each infusion was for – nettle for my blood, raspberry for my uterus, comfrey for my placenta.

When I’d talked to Judy (the herbalist I ordered my herbs from) I’d told her my situation and she reminded me about the importance of language. She picked up on me saying “I don’t want a cesarean” and reminded me that the universe doesn’t hear the “don’t” part. She gave me an affirmation to use: “I am having a vaginal birth and it is easy. My baby and I are perfect and healthy and safe. All is well.” I also started going for acupuncture treatments to help my placenta move up.

I also went to see the OB I’d met at my local hospital. If I was going to have a hospital birth I was going to need an OB and he had seemed like a reasonable guy. He was respectful of the fact that I was a homebirther and that hospital birth was completely out of my comfort zone. I went with an open mind and the intent of finding some agreeable terms for me to have my baby in the hospital. I had some legitimate concerns about homebirth in my situation. Mainly that if I started to bleed badly, either before or after the birth, we wouldn’t be able to handle it at home and were too far away from the hospital to get there in an emergency. We live at least a ½ hour from the nearest hospital in good weather. Since my baby was due in November we couldn’t count on good weather. When I talked to the OB about my concerns and my preferences he was fairly reasonable. He said that I had the right to make whatever choices I wanted and that they couldn’t do anything to me that I didn’t want them to do. So he talked a good line and made hospital birth sound like a viable option, but even then there were lots of little things that were setting off alarms for me. Like when I first went to the hospital with my bleeding I was sent directly to L&D and the first thing the nurse did when she showed me to an exam room was to tell me to take off my clothes and put on a gown. I asked her why I needed to take off my clothes when all they were going to do was use a doppler to check my baby’s vitals. She said that most women like to put on the gown just in case the doctor wants to do an exam but I said no thanks. They also tried to get me to sit in a wheelchair at the hospital, first they wanted to wheel me to L&D and then again from the exam room to the ultrasound. Both times I refused. The second time the nurse had gone to ask the doctor’s permission for me to walk, which I didn’t understand. At 35 years old I don’t see why I’d need anybody’s permission to walk anywhere. Then at the doctor’s office the nurse had wanted to weigh me and get me to pee in a cup and put on a gown. All of which I refused, saying “Oh no thanks, I don’t do that.” Of course, she’d had to go and ask the doctor if I was allowed to do that. Then when I was talking to the doctor about the birth and explaining that my husband or I always caught the baby he said that that was fine but that he “might just have my hand on top of his to guide him”. That really didn’t sit well with me, or my husband for that matter. Having brought our first three children into the world by ourselves we really couldn’t fathom what this guy thought he’d be doing with his hands between my legs while our baby was coming out. Despite my best intentions to be open to a hospital birth, I was having second thoughts.

Then at 36 weeks the baby dropped, which was weird because mine don’t usually come early. When faced with the prospect of being in labour and going to the hospital I realized that I didn’t want to do it. A number of times already I’d started crying, like while doing the dishes or something, and when my husband asked me what was wrong I’d say that I didn’t want to go to the hospital. But at that point I was still telling myself that staying home wasn’t an option this time. At the same time I’d started having dreams where I’d be screaming angry at someone for cutting off my hair. Symbolically a person’s hair represents their power; my dreams were telling me that I’d be really angry if I gave my power away. I had to accept that this less-than-ideal situation I found myself in was still mine to deal with, that the fact that I was no longer having a simple pregnancy didn’t automatically mean that I was going to be able to absolve myself of the responsibility of dealing with it. This is a lot of what UC means to me. It’s not just about avoiding unnecessary interventions and the many other abuses that come with the modern western way of birth. It’s about taking responsibility for myself, my body and my baby and knowing that each birth is my journey and my task, that whatever is given to me is mine to address.

36 WEEKS TO 40 WEEKS

At 36 weeks I was drinking infusions, visualizing a strong placenta, affirming a safe and easy birth and having weekly acupuncture. My husband and I had started talking homebirth or maybe birth in a hotel near the hospital. I was still afraid of a c-section, especially an unnecessary one, so we were talking about how we’d handle a hospital birth if we ended up going there. I had talked to Gloria Lemay and Susun Weed. All was well. And then I woke up at about 4 a.m. and felt wet between my legs. It was the night after the baby dropped and I wondered if it was my water breaking. I went to the bathroom and saw blood running down my legs. When I turned on the bedroom light there was a blood clot sitting on my bed. It was about the size of a small pancake, oval shaped and about ½ an inch thick and it was sitting in a pool of watery blood. I woke my husband up and we talked about what to do. I was having some contractions, they felt like Braxton hicks, but given that the baby had dropped and now there was all this blood, I wondered if the baby was coming. We talked about what to do and I have to say that my husband is such a blessing as a birth partner, no matter what’s happening he is so calm and has such faith in the process. We lay there in bed and watched the baby move in my belly. My husband listened to his heart rate and it was normal. And we watched my bleeding to see if it continued. Gloria had told me that bleeding that could be measured in tablespoons was acceptable but that bleeding that was approaching a cup or more was not. We estimated the clot was a few tablespoons and the rest of the blood was about 2-3 more and it had stopped. I asked if my husband wanted to go to the hospital and he asked, Why, what will they do? We figured that at best they could hook me up to machines to monitor the baby and at the worst we could get some completely spastic doctor that would want to cut the baby out of me at 36 weeks for who knows what reason. So we stayed home.

The same thing happened about a week later, except that I woke up to a gushing sensation and the clot wasn’t nearly so big. Again we estimated the blood loss, checked the baby’s heart rate and activity, and decided to stay home.

The doctor had given me the phone number of the head obstetric nurse at the hospital so I could talk about their policies and procedures. He had explained to her that we were a homebirth family and that we were really only interested in being in the hospital as a precautionary measure. They assumed that I’d be agreeable to the heparin-lock but I told her that I wasn’t and that I thought having a needle stuck in my hand would be uncomfortable and distracting. I forget how often she said they like to monitor the baby but I said I’d refuse that too. The nurse said that some of the nurses would get snippy with me for refusing but that I should ignore them. She also told me that the nurses would be told not to check my dilation because of my previa. I told her that no one would be checking my dilation because of my previa and she said I’d need to talk to the doctor about that. I didn’t understand why, it’s not like he would have any say in it. I asked her about all of their standard newborn procedures and told her I’d be refusing those too. I could tell she was trying to be accommodating but it really wasn’t going that well. The final straw for me was when we came to the issue of the placenta and the cord. I explained to her that my husband always cuts the cord, which she was okay with though for some reason she thought he’d need help with it. Then I told her that we leave the cord intact until the placenta is born and she was silent. After a minute or so she said “Oh…” I don’t think she’d ever heard of that before and didn’t know what to say. Once she regained her bearings she told me that I’d have to discuss that with that with the doctor because that was his decision. I told her that she didn’t understand, that my husband would not allow anyone to touch the cord before the placenta was out. That he would physically prevent them if necessary and that it wasn’t negotiable. That made her very uncomfortable and she again told me I’d have to discuss it with the doctor. And then came the deal breaker. When I told her that we would be taking the placenta home she said they couldn’t give it to us, that the health board doesn’t allow them to, that it wasn’t negotiable.

By the end of the conversation I knew I would be having my baby at home. Besides how misguided they were about whom the placenta belongs to, I realized there was a serious disconnect between the nurse’s view of the situation and mine. Essentially, she thought that the doctor was going to be in charge at my birth, whereas I thought I would be. I knew then that I wouldn’t be going anywhere near a hospital whilst in labour unless I was dying.

Aside from just how wrong and bizarre most of their thinking was, my husband and I realized that the hospital actually had very little to offer us. They offer the illusion of safety, but an illusion is all that it is. When we looked past all of their technogizmos and protocols we saw that the two things they had that we didn’t were monitors and surgery and we decided that if we needed monitors or surgery then we’d go there. We also decided to cancel the appointment for the second ultrasound. Both doctors had put a lot of stock in knowing the exact distance between placenta and cervix, but to me it wasn’t so important. I wouldn’t plan a c-section just because it hadn’t moved as far as the specialist had predicted.

After that I went back to preparing for the arrival of my baby. I continued my infusions, visualizations, affirmations and yoga and all was well. Then at about 40 weeks I stood up from a chair and walked into the kitchen and felt a gush. I hoped it was my water breaking, though even that would be weird because my water’s never broken before, but when I went to the bathroom I saw it was blood. Probably a few tablespoonfuls. I was pretty sure the baby was napping so there wasn’t much movement but his heart was normal and I managed to get him to squirm a couple times after nudging him. Still, I was very upset. I have a couple friends who really understand UC and they heard from me a fair bit the last few weeks of my pregnancy. I talked to them because I knew they understood where I was coming from, that I was scared but that fear alone wasn’t a good enough reason to go to the hospital.

After the bleed at 40 weeks I had a few days respite and then I had bleeds three days in a row starting at 41 weeks. Prior to this my longest pregnancy had been 40 weeks 6 days; it never occurred to me that I’d still be pregnant at 41 weeks. I was wondering if this baby was ever going to come out and then my placenta started bleeding again. That was really upsetting. But the baby was still moving normally and I figured that if I went into the hospital at 41 weeks with a bleeding placenta they’d feel compelled to try and do something. So I stayed home. After the third bleed I realized that it was always happening after I got up from sitting on the living room furniture. I’d tried putting cushions under my butt to keep my spine straight but it hadn’t helped. What was happening was that the placenta was on the bottom back wall of my uterus and whenever I sat down the baby’s head was pushing into the placenta and making it bleed. I think that’s also why I passed the big clot after he dropped at 36 weeks. Up until then he’d been sitting really high on my right side but when he dropped he went LOA. I think that’s why he kept on switching back and forth because no matter how much time I spent doing Cat and Cow positions in yoga my baby would not stay anterior. Once I realized that sitting was making my placenta bleed I just stopped doing it. I spent the last 3 days of the pregnancy standing, kneeling, or lying on my side. It was uncomfortable and a little boring and I was beginning to wonder if the pregnancy would ever end but I didn’t bleed again after that.

My husband and I spent a lot of time preparing for the birth, reviewing all of the hemorrhage treatments we had. I’d had a bit of luck and my TCM practitioner had given me Yunnan Baiyao pills for controlling bleeding and shown me the acupuncture points to stop uterine hemorrhage. I’d had him mark the points with a black marker for my husband. The one tincture I’d been unable to find on the island was witch hazel bark but I asked around and found an herbalist who grows it and she gave me an ounce.

THE BIRTH

I started having regular contractions after the first bleed at 41 weeks. They had gotten to 5 minutes apart and I thought labour was starting but then they just stopped. After that there was nothing for a couple days and then I started having low cervical contractions early in the morning. They’d start at about 4 am and stop by about 7 am when the kids got up. There were three days of that and I was really beginning to wonder when this baby was going to come out. I hadn’t sat down for three days and I was having contractions every morning. Then finally, at 41 weeks 4 days, after dinner when my husband was putting the kids to bed I had a few contractions that felt like they were going somewhere. There were only a few of them in an hour but they were intense.

By 8:15 p.m. I’d had a few more contractions and my husband was watching something banal on TV. I’d told him that I thought I might be in labour but that it still wasn’t consistent. I was in the living room saying that I wasn’t sure if the contractions were picking up yet and he asked me if the TV show was distracting me, instantly I realized how irritating the show he was watching was and told him to turn it off. At 8:30 I had another contraction and it was painful. A few minutes later I had another one and holy crap was it really painful. I told him I was having more contractions but he didn’t get it. He was in the kitchen getting some ice cream and I had this contraction that went on and on and on and it really hurt and I yelled at him “Now is not a good time for you to be getting ice cream!” And then he understood that I was serious about this labour thing and came to be with me. I didn’t really need him to do anything I just like having him around when I’m in pain. He asked if I was sure this was it and I said Yes and asked if he was okay with staying home and he said Yes and went to get my birth kit. Over the next hour I had a number of contractions that were insanely painful. The baby was somewhere between ROT and ROP, I knew this because he had kicked a number of times while I was having a contraction and his feet were over on the left front side of my belly.

I had about 10 or 15 of those insanely painful contractions and then they stopped for a few minutes. I waddled into the kitchen to get a glass of water and while I was at the sink I got this contraction that felt like pushing so I pushed a bit and thought ‘Am I pushing?’ I pushed again with the next contraction and a glop of fluid ran down my legs. I took my underwear off to see if there was blood but there was just clear fluid. I pushed a couple more times and felt the baby move down and then he stopped. I’d had this with my last posterior baby; getting the back of the skull past the tailbone is hard. I tried hanging on to the counter for leverage and pushing hard but nada, nothing budged. My husband had come in to the kitchen and asked me if I wanted to come into the living room where all the birth stuff was but I said No way am I moving, so he brought some towels and the birth basket in the kitchen. I got on my knees and pushed again but still nothing was moving, and I thought Oh shit how am I going to get this baby out? I scuttled around a bit, got myself in a better kneeling position and with the next contraction pushed hard and yelled, I felt a bit of movement so I pushed harder and yelled louder and suddenly the whole baby shot down and the head was crowning. I felt myself stretching a lot and put my hands down to support where it was burning and I realized the baby’s head was at a weird angle. Instead of facing directly front like my last posterior baby he was looking at the inside of my thigh, so I had to ease him out slowly to avoid tearing. Once the fullest part of his head was out his body shot out along with the rest of his amniotic fluid. He started crying right away and I pulled him up and checked his sex and said “Oh Thor you’re here!” It was such a relief to finally be holding my baby.

Sitting on the floor holding my baby I did start to bleed more than usual but my pot of witch hazel was sitting right there on the stove so my husband poured me a glass and I gulped it. I thought it would taste horrible and acrid but it was actually kind of tasty so I think I must have really needed it. After about 10 minutes I moved to the living room where it was more comfortable. We spent some time loving our baby and after a while the placenta came. The fetal side of the placenta looked fine but when I tried to turn it over it was like trying to grab jello. The maternal side was jiggly and one edge was sloppy and coming apart and had a few pieces missing. The other pieces of the placenta came out over the next half hour and when my bleeding eased up Thor and I went up to bed. He took to nursing with great zeal and I had some wicked after pains that night but I was happy. I’d had my baby at home and all was well.Written by Alice, July 2010

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22 thoughts on “Marginal Placenta Previa Birth”

This is an awesome birth story. Thank the parents for sharing it. It was great that the mother put in all the feelings and thoughts she was having as pregnancy, labor and birth were going on. Kudos to her on standing up for her rights and seeing those red flags.

I love her. And her story. Just an hour before I read Alice’s birth story here I read the Who Controls Childbirth essay at self.com. That made me angry.
How different.
It was very refreshing to read her thinking process. It is disturbing to me that every woman in a hospital birth or a homebirth transfer will just sit in that darn wheelchair just because she is told to.
Why do we turn into such little girls afraid to say anything so that we just shut up, close our eyes and take it all in, and let them have their way with us. As long as we are ‘healthy’ and have ‘healthy’ babies right? Wrong. We are not healthy and our kids are not healthy either. Constantly someone telling us what we can and cannot do. That is why I have no childcare. my kids don’t like to be told that they cannot climb a dirty tree stump and I tell them that it is OK for them not taking it in. I don’t like when someone is insisting they need training wheels in order to learn how to ride a bike. Catch my drift? 😀
Off to bed.

Wow, here’s a woman who didn’t give in to the “what ifs” and fears, who didn’t compromise and sell out, but instead keept the faith and jumped in with both feet…and what an affirmation of life it was in the end! Fear and safety are illusions after all. Like Helen Keller said, “Security is mostly a superstition. It does not exist in nature. Life is either a grand adventure or nothing ….” Thanks for the inspiration.

Wow, wow, wow. I really needed to read this, so thank you for posting the link on FB. The only “medical” checking I wanted for this pregnancy and home birth was to check for placenta location since I’ve had two prior cesareans. And when my midwife took a look, the placenta was along the back wall of my uterus but close to the cervix. I was right at 17 weeks during that check. I know it typically moves up over the span of the pregnancy and I will continue to visualize that movement…even assuming that it has already moved by now (I’m about 28 weeks, now). But what a courageous, strong story this one is. I appreciate her sharing the details so much!

OMG, that was truly inspirational! Trusting your instincts sure does pay off in the end! I’m so glad it worked out great like that, thanks for the tip on witch hazel for bleeding, I bled more than usual for my first one (no placenta previa), and I want to make sure that everything is good to go for the next one.

You are truly a clear thinking individual, who didn’t let the medical people bully you into anything you didn’t want to do. That is so great!!! You got guts! 😀

dear gloria, i thank god for knowing this topic in your blog.
i live in indonesia, south east asia.
what kind of remedy can iuse to replace the witch hazel bark?

what can i do if i had such a situation and there is no acupuncture specialisit around me?

if it is a condition of placenta previa totalis, do i have any choice but the c section?

from this case,
i learnt that no need to rush to deliver the placenta.
is that mean that even if i had placenta increta/acreta, all i need is just to be patient until i have the next contraction to deliver my placenta?

DC Gloria, I’m not a midwife, but I do know the answers to some of your questions.

Previa is a nasty complication. When it persists to term, it kills healthy women and healthy babies, unless there is surgical intervention. If your condition is placenta previa totalis, you do not have any choice but the c-section.

I hope that your previa clears up (many do), and that you have a peaceful and healthy birth.

This is an amazingly inspirational birth story! I just found out today that I have placenta previa at 30 weeks. I’ve been searching the web all night for helpful treatments and some kind of reassurance that I can still have a natural birth. I want to thank you for posting this story because I have found reassurance knowing that it is possible to envision and remind myself that my baby and I can do this.
You are such a strong and admirable woman! Thanks for the inspiration !

Thank you so much for posting this beautiful birth story! I am in Southern California, 37 weeks along, don’t see the need for a cesarean for my marginal placenta previa, and want to have an unassisted homebirth with my husband. I’m a childbirth educator, had a beautiful HypnoBirth the first time around with our son (no pain, one hour from arrival at hospital to holding our baby, and no interventions). Since I gave birth in a hospital though, we got bullied quite a bit. We were young, inexperienced and deviated from our birthplan quite a bit because of the western medical pressures we were faced with. This was exactly what I needed to read. What a blessing!

Thank you for sharing this. I’m pregnant with my fourth baby and birthed the first three in hospitals but with midwives and without any intervention. Yesterday, after being on the fence about whether or not to even have an ultrasound, I found out that my placenta may be very close to my cervix. The u/s tech said that the position isn’t likely to change this late in pregnancy, but we had this u/s before 20 weeks, and everything that I’ve read since yesterday’s appoint indicates that it likely will change. Your post gives me hope that even if the placenta doesn’t migrate, and if I risk out of our birthing center as a result, I may not have to have a medicalized hospital birth, which terrifies me. Thank you for giving me hope.